Introduction“AIDS is no longer [just] a disease. It is a human
rights issue.” After twenty-five years, the global AIDS pandemic is still expanding. More than forty million people are living with HIV/AIDS. In 2005, five million people were newly infected, and three million died of AIDS. Between 2003 and 2005, the number of people living with HIV in East Asia rose by more than 25 percent, and the number of people living with HIV in Eastern Europe and Central Asia rose by more than one-third. However, sub-Saharan Africa remains by far the worst-affected region.1 Countries such as Lesotho and Swaziland, with nearly one in three adults infected, are openly presented as possibly being the first countries to “die” of AIDS. Why has the epidemic spread so inexorably across the globe? Why have countries failed to act—or acted so ineffectually—to stop the epidemic from progressing? It has been acknowledged for almost as long as HIV has been recognized that HIV/AIDS is fundamentally tied to human rights abuses.2 But such acknowledgment has had surprisingly little impact on the global response to the epidemic, and this failure explains, to a large extent, why we have made so little progress. Worldwide, vulnerability to HIV/AIDS is linked to populations marginalized by society because of their gender, race/ethnicity, sexual orientation, or social or economic class. Human rights are central both to our understanding of the dynamics of the disease and to how we must combat it. HIV/AIDS is commonly thought to be related to “economic, social, and cultural rights” (such as the right to health care), as opposed to “civil and political rights,” such as freedom of expression and association and due process of law. However, many of the human rights abuses that most increase HIV risk—violence and discrimination against women and marginalized populations as well as people living with HIV/AIDS, harassment and imprisonment without due process of outreach workers and at-risk populations seeking HIV/AIDS information or services, and censorship of health information—are abuses of civil and political rights. The fact that these abuses have a concrete impact on the health of individuals underscores what has been called the “indivisibility” of human rights norms—the notion that civil and political rights and economic, social, and cultural rights are mutually reinforcing and derive from a single principle: the fundamental dignity of each human being. While there is widespread, though by no means universal, recognition that social stigma can fuel the epidemic, and that the characteristics of HIV infection do not warrant intrusive restrictions on liberty, all too often these basic understandings are not reflected in law or in concrete policy terms. Equally important, there is uneven (at best) appreciation of the broader human rights issues that contribute to the continuing spread of the disease. Most perversely, some of the critical lessons about stopping HIV/AIDS, learned painfully and acted on with positive results in the 1980s and 1990s, are now being disregarded. Even while treatment options are expanding, responses to HIV/AIDS in many places are getting further from the kind of science-based, human-rights informed response that has been proven to stop the spread of the disease. Left unaddressed, human rights abuses will undermine both HIV/AIDS prevention and treatment.
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